The geometry of communication in medicine

For most of my training, I assumed communication was a straight line. Say the thing. The other person hears the thing. Why complicate it? Only much later, in a small seminar room at St. John’s College in Santa Fe, did a tutor named Charlie Fasanaro loosen that idea. He walked us through Euclid the way you might guide a child who is learning to see. I had no sense then that those early lessons would come back to me years later in operating rooms, meetings, and marriages.

A flat page is Euclid’s world. Lines behave. Parallel lines never touch. Many physicians still expect conversations to work like that. We give an instruction on the ward or make a simple comment in a meeting and assume the meaning will travel in a straight path to the listener.

But human beings rarely live on flat paper.

Some conversations behave like a globe. Draw two “straight” lines on a globe. Begin at the equator, walk north, and they will eventually meet at the pole. We feel this in clinical conversations all the time. Two colleagues start apart, even disagreeing, yet their shared concern for a patient pulls them gradually toward the same point. The geometry of the moment helps them meet.

More commonly, other conversations follow a very different shape, the shape of a saddle. When I say saddle, I mean it literally. Think of a horse saddle with its gentle dip in the middle and its raised front and back. Nothing about it is fully flat. If you place a marble on that surface, you cannot predict where it will roll. It might drift toward you, then veer off to the right, then slip away entirely. The shape underneath controls the path.

Many difficult conversations behave exactly like that. Two people begin close, speaking in good faith, but the ground beneath the moment has curves. Fatigue. Worry. Pride. An old wound. A difference in temperament. The words slide off their intended path. That is why a neutral question can be heard as criticism, or a calm request can land like pressure. It is not the content. It is the shape of the surface underneath.

This matters for physicians because most communication failures have very little to do with intelligence or intent. They come from curvature, the invisible contours between two people. What feels obvious in our own mind bends as it crosses into someone else’s world.

Two forces shape that space more than anything.

One is background. A direct surgeon sounds efficient to themselves and abrupt to someone who values steadiness. A cautious colleague hears pressure where none was meant. Years of training, family expectations, DISC profile tendencies. All of it curves the ground.

The other is emotion. Fatigue from call. Fear about being judged. Shame from an earlier mistake. Even pride. These tilt the surface underfoot and make meaning slip.

Once you start seeing this, everything changes. Before insisting we are being clear, we pause and ask a different question. What does this sound like in their world? Are they standing on the flat page we imagine, or on a globe, or on a saddle of their own?

That small shift is not simply theory. It is practical kindness. It steadies the surface just enough for meaning to hold its shape. And every once in a while, if we listen closely enough, we may hear Mr. Fasanaro reminding us that geometry is less about understanding and more about being understood.

Patrick Hudson is a retired plastic and hand surgeon, former psychotherapist, and author. Trained at Westminster Hospital Medical School in London, he practiced for decades in both the U.K. and the U.S. before shifting his focus from surgical procedures to emotional repair—supporting physicians in navigating the hidden costs of their work and the quiet ways medicine reshapes identity. Patrick is board-certified in both surgery and coaching, a Fellow of the American College of Surgeons and the National Anger Management Association, and holds advanced degrees in counseling, liberal arts, and health care ethics.

Through his national coaching practice, CoachingforPhysicians.com, which he founded, Patrick provides 1:1 coaching and physician leadership training for doctors navigating complex personal and professional landscapes. He works with clinicians seeking clarity, renewal, and deeper connection in their professional lives. His focus includes leadership development and emotional intelligence for physicians who often find themselves in leadership roles they never planned for.

Patrick is the author of the Coaching for Physicians series, including:

He also writes under CFP Press, a small imprint he founded for reflective writing in medicine. To view his full catalog, visit his Amazon author page.